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CSF PCR Testing for Enterovirus Reduces Length of Stay for Infants

Infants with positive PCR results had 1.5-day shorter length of stay.

Young infants often are hospitalized for fever and are started on antibiotics until all bacterial culture tests are negative. Investigators retrospectively evaluated the effect of regular use of cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing for enterovirus on hospital length of stay and antibiotic use during the height of several enteroviral seasons (June 1–October 31, 2000–2006) in 442 infants (age, 90 days) with suspected aseptic meningitis. Infants ultimately diagnosed with serious bacterial infection or herpes simplex virus infection were excluded.

All infants underwent enterovirus PCR testing within 48 hours of hospitalization, and results were available after a mean of 23 hours. CSF PCR was positive for enterovirus in 35% of infants. Compared with infants with negative PCR results, those with positive PCR results had significantly shorter mean hospital stays (1.5 fewer days) and duration of antibiotic use (34% shorter). The results were similar in patients with (185 infants) and without (257 infants) CSF pleocytosis.

Comment: Some question whether routine use of CSF PCR affects care. At least in this study, when used during the enteroviral season in a setting with a rapid turnaround time, it reduced both length of stay and antibiotic use. It might also shorten hospital stays for older children and adults with suspected viral meningitis who are admitted for antibiotic coverage until CSF bacterial cultures are negative.

— Howard Bauchner, MD

Published in Journal Watch General Medicine September 27, 2007

Citation(s):

King RL et al. Routine cerebrospinal fluid enterovirus polymerase chain reaction testing reduces hospitalization and antibiotic use for infants 90 days of age or younger. Pediatrics 2007 Sep; 120:489.

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